HB506: HB506 Social services; Medicaid coverage for tobacco cessation treatments; provide

Georgia's Surprise Billing Consumer Protection Act (O.C.G.A. Chapter 20E of Title 33) already limits some surprise medical bills, but this bill rewrites the section covering ground ambulance transportation. It requires health plans to treat emergency ambulance rides as a covered service whenever a first responder, such as a firefighter, paramedic, EMT, or police officer, calls for one. For ambulance providers outside an insurer's network, the bill sets a minimum reimbursement rate: whatever rate a local government has agreed to by contract or ordinance, or if none exists, the lesser of 325 percent of the Medicare rate or the provider's billed charges. Patients cannot be charged more in copayments, coinsurance, or deductibles than they would owe for an in-network ambulance ride, and insurers must pay ambulance providers directly within 30 days of a clean claim. The changes take effect January 1, 2027.

• Requires health plans to cover emergency ground ambulance transportation as a covered service whenever it is requested by a first responder like a firefighter, paramedic, EMT, or police officer.
• Sets a minimum payment rate insurers must pay out-of-network ambulance providers, based on local government agreements or, absent one, the lesser of 325 percent of the Medicare rate or the provider's billed charges.
• Caps what patients pay in copayments, coinsurance, or deductibles for an out-of-network ambulance ride at no more than they would pay for an in-network ride.
• Requires insurers to pay ambulance providers directly, not the patient, within 30 days of receiving a complete ('clean') claim.
• Requires insurers to notify ambulance providers within 30 days if a claim is denied or needs more information, and to state the reasons or the missing information.

Georgia patients who use ground ambulance services, especially those transported by an out-of-network provider; health insurers regulated under the Surprise Billing Consumer Protection Act; ambulance providers, including local government and volunteer fire department services; and first responders such as firefighters, EMTs, paramedics, and police officers.

Patients who need an ambulance often cannot choose which provider responds, and this bill limits how much they can be billed out of pocket for an out-of-network ride while guaranteeing ambulance providers a minimum payment from insurers, changing who bears the cost of gaps between insurance networks and actual ambulance charges.

• Section 1 rewrites O.C.G.A. § 33-20E-23 to define terms such as ambulance provider, clean claim, covered service, emergency transport service, and first responder.
• Subsection (b) requires health plans to treat ambulance transport as covered whenever a first responder requests it.
• Subsection (c) sets the minimum reimbursement rate for out-of-network ambulance service, defaulting to the lesser of 325 percent of the Medicare rate or the provider's billed charges when no local agreement exists.
• Subsection (d) says a covered person's payment obligation ends once the insurer pays the ambulance provider, aside from copayments, coinsurance, or deductibles.
• Subsection (e) caps a patient's copayment, coinsurance, or deductible for out-of-network ambulance service at the same level as for in-network service.
• Subsection (f) requires insurers to pay ambulance providers directly within 30 days of a clean claim, or send written notice within 30 days explaining a denial or requesting more information.
• Section 2 sets the effective date as January 1, 2027.
• Section 3 repeals conflicting laws.

1. 2026-05-12Effective Date 2027-01-01
2. 2026-05-12Act 624
3. 2026-05-12House Date Signed by Governor (House)
4. 2026-04-10House Sent to Governor (House)
5. 2026-04-02House Agreed Senate Amend or Sub (House)
6. 2026-03-31Senate Passed/Adopted By Substitute (Senate)
7. 2026-03-31Senate Third Read (Senate)
8. 2026-03-25Senate Committee Favorably Reported By Substitute (Senate)

• Scott Hilton (R, HD-048)Primary sponsor
• Karen Mathiak (R, HD-082)
• Deborah Silcox (R, HD-053)
• Ron Stephens (R, HD-164)
• Michelle Au (D, HD-050)
• Shawn Still (R, SD-048)

1. PassedHouse voteMarch 6, 2025

   142 yea, 31 nay (1 not voting, 6 absent)

   Passage: House Vote #258

2. PassedSenate voteMarch 31, 2026

   48 yea, 0 nay (0 not voting, 6 absent)

   Passage By Substitute: Senate Vote #894

3. PassedHouse voteApril 2, 2026

   168 yea, 2 nay (2 not voting, 4 absent)

   Agree To Senate Substitute: House Vote #835

• surprise medical billing
• ambulance services
• health insurance
• emergency medical services